Provider Demographics
NPI:1710334560
Name:GAULMAN, LESHAN ANDRE (LMSW)
Entity Type:Individual
Prefix:
First Name:LESHAN
Middle Name:ANDRE
Last Name:GAULMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 NEEDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1548
Mailing Address - Country:US
Mailing Address - Phone:646-842-1514
Mailing Address - Fax:
Practice Address - Street 1:1465 NEEDHAM AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1548
Practice Address - Country:US
Practice Address - Phone:646-842-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker